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  Issue 6, March
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GvHD Skin Care Interventions

Roel de Weijer,
Nurse Specialist Haematology, UMC Utrecht (The Netherlands)
R.deWeijer@umcutrecht.nl


Last year at the EBMT congress we had a workshop titled ‘skincare after SCT ‘. Here, I would like to provide a summary and conclusion of the workshop.

GvHD is the most common complication after stem cell transplantations (Socie et al 1999, Vogelsang et al 2004); there are many studies done about GvHD, but none of the studies give the answer to ‘how to treat GvHD’ (Gaziev et al (2001). Most of the studies are medical and a few are from other disciplines. Most literature currently used by nurses are based on descriptions of a particular case.

One of the objectives of the workshop was to talk with other nurses in Europe about what they are doing for patients with GvHD. After an introduction and some questions we discussed things in small groups and later on in the whole group. There where a lot of interventions mentioned, most of these being medical, which amazed me as I assumed most interventions would be based on the nursing care as it’s the nurses who mostly deal with GvHD patients.

We all know that the medical treatment is not the only patient solution. We can treat patients for their GvHD, but a lot of them (more than 40%) do not respond to the treatment (Akpek et al 2002). So, what can we do as nurses for these patients? In this particular workshop we concentrated on skincare. Beside the medical treatment it was hardly mentioned what we as nurses do and what kind of advice we can provide. But, here are some interventions we all seem to be aware of and actively execute:

  • We all advise patients to use an oil based cream/lotion to care for their skin. Every country had its own particular brand it used but this was difficult to compare. In reality we don’t really know if its better to hydrate/moisturise skin before or after using the oil based cream/lotion. It seems logical to moisturise the skin but we concluded that as there is no evidence, we have to work with interventions based on experience.
     
  • There is a difference between the south and the north of Europe. We all give the advice to the patients to protect their skin from sunlight using a cream with an SPF of 20 and to wear clothes. But in the south of Europe they also advise patients to protect their skin when inside by closing curtains and using sunscreens. We all appear to advise the patient to wear clothes made from natural fibres (linen, cotton or silk).
     
  • None of the nurses we spoke to where familiar with massage techniques for the skin or suitable exercises.

I think its safe to say that we can support a better quality of life for a GvHD patient if we know how to provide a skin massage – the skin may stay in a better condition. In the literature available you can read that massage of the skin can help the patient, but they don’t describe how to do it (Vogelsang 2001). Even so, I think it would be better for the patients if they are doing some exercise for their joints in the places where there is some GvHD on the skin. If they do the exercise the joints will be moving and the skin will be slightly less stiff - it will be better for the skin, but also for the joints. If the skin is stiffened, patients prefer not to move too much because it is inconvenient. And later on they can not move at all because the joint is so stiff it can get locked.

My conclusion from the workshop is that all nurses wanted to have interventions for their GvHD patients, but there are no evidence based interventions. Thus, it is hard to know what to do.

I believe the start for better interventions will be to tell each other about what you are doing and why, together we can become of more interventions which we can adopt in our workplaces. We should discuss this problem in our own department/ hospital, national groups or international groups such as the EBMT.

I hope you can make contact which other colleagues and discus your problem. Together we can do it!!

  1. Akpek, G. (2002) Clinical Grading in Chronic graft-Versus-Host Disease: Is it Time for Change?: Leukemia and Lymphoma: Vol 43, No 6, 1211-1220.
  2. Gaziev, D. Lucarelli, G. (2001). Novel approaches to the treatment of chronic graft-versus-host disease: Expert opinion on investigational drugs: Vol.10, No 5, 909-923.
  3. Socie, G. Mary, J. Esperou, H. et al (2001). Health en functional status of adult recipient 1 year after allogeneic haematopoietic stem cell transplantation: British Journal of Haematology: Vol 113, 194-201
  4. Vogelsang, G.B. (2001). How I treat chronic graft-versus-host disease: Blood: Vol 74, 1196-1201.
  5. Vogelsang, G.B. Higman, M.A. (2004). Chronic graft versus host disease. British Journal of Haematology: Vol 125, 435-454
     

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